JP6359312B2 - X-ray diagnostic equipment - Google Patents

Description

An embodiment as one aspect of the present invention relates to an X-ray diagnostic apparatus .

  2. Description of the Related Art In recent years, aortic valve replacement (TAVI) or catheter-transient valve replacement (TAVR) techniques using a catheter have attracted attention. The aortic valve replacement procedure is performed, for example, in a procedure room equipped with an X-ray diagnostic apparatus. That is, the aortic valve replacement technique is a technique in which an artificial valve is placed in the heart of a subject while observing a fluoroscopic image collected in real time by an X-ray diagnostic apparatus.

  In the aortic valve replacement procedure, it is important to place the prosthetic valve at an accurate position while referring to a fluoroscopic image. Specifically, the artificial valve is such that the lower end of the artificial valve is lower than the bottom of the original valve, and the upper end of the artificial valve is above the leaflet tip of the original valve and below the coronary artery. Is the goal.

  A technique for displaying a composite image based on a contrast image and a fluoroscopic image of a subject is disclosed (for example, see Patent Document 1).

JP2013-158372A

  In the aortic valve replacement procedure, when a calcified site is present on the aortic wall, the catheter tip may come into contact with the calcified site during catheter advancement. When the leading end of the catheter comes into contact with the calcified site, the calcified site is separated from the aortic wall and flows through the aorta, and cerebral infarction occurs as a complication.

  In order to avoid contact with the calcification site at the leading end of the catheter, it is necessary to display an appropriate real-time image on the operator side. In the conventional technique, contrast is formed on a real-time fluoroscopic image using bones as landmarks. An image obtained by fusing (combining) the entire image was displayed. According to this conventional composite image, a shift occurs between the aorta position on the fluoroscopic image and the aorta position on the contrast image, which is moved by the pulsation of the heart. It was very difficult to avoid contact with the site.

In order to solve the above-described problem, the X-ray diagnostic apparatus according to the present embodiment is disposed opposite to an X-ray generation unit that generates X-rays with respect to a subject, and the X-ray generation unit. An X-ray detection unit for detection, a fluoroscopy image generation unit for sequentially generating a fluoroscopic image of a plurality of frames based on the X-ray, and a partial volume based on the contrast volume data of the subject obtained in advance A calcified region image generating means for generating a calcified region image relating to the calcified region; a detection unit for sequentially detecting the calcified region on the plurality of frames of the perspective image; and A display control unit that sequentially superimposes the generated calcified region images on a position and displays the images on the display unit.

Schematic which shows the structure of the X-ray diagnostic apparatus which concerns on this embodiment. The perspective view which shows the external appearance structure of the X-ray diagnostic apparatus which concerns on this embodiment in the case of providing an overhead traveling type C arm. The block diagram which shows the function of the X-ray diagnostic apparatus which concerns on this embodiment. The figure which shows an example of a contrast volume. The figure which shows an example of the fluoroscopic image in the end diastole of the heart. The figure which shows an example of the fluoroscopic image in the end systole of the heart. The figure which shows an example of a calcification area | region image. The figure which shows the chest contrast image aligned with the fluoroscopic image of the end diastole by a prior art. The figure which shows the chest contrast image aligned with the fluoroscopic image of the end systole by a prior art. The figure which shows the calcification area | region image aligned with the partial area | region of the fluoroscopic image of the end diastole by the alignment means which concerns on this embodiment. The figure which shows the calcification area | region image aligned with the partial area | region of the fluoroscopic image of the end systole by the alignment means which concerns on this embodiment. The figure which shows an example of the synthesized image based on the perspective image of the end diastole displayed by the display control means which concerns on this embodiment. The figure which shows an example of the synthesized image based on the perspective image of the end systole displayed by the display control means which concerns on this embodiment. The flowchart which shows operation | movement of the X-ray diagnostic apparatus which concerns on this embodiment. The flowchart which shows operation | movement of the X-ray diagnostic apparatus which concerns on this embodiment. The figure which shows an example of the synthesized image with which the characteristic information was synthesize | combined.

An X-ray diagnostic apparatus according to this embodiment will be described with reference to the accompanying drawings.

  FIG. 1 is a schematic diagram showing the configuration of the X-ray diagnostic apparatus according to the present embodiment. FIG. 2 is a perspective view illustrating an external configuration of the X-ray diagnostic apparatus according to the present embodiment when the overhead traveling C-arm is provided.

  1 and 2 show an X-ray diagnostic apparatus 1 of the present embodiment for performing a procedure using a catheter, for example, an aortic valve replacement (TAVI or TAVR) procedure. The X-ray diagnostic apparatus 1 is not limited to the aortic valve replacement procedure, and may be a procedure that should avoid contact between the catheter leading end and the calcification site, for example, a stent graft placement.

  The X-ray diagnostic apparatus 1 is mainly composed of a gantry device 2, a bed device 3, a controller 4, and an image processing device (DF: digital fluorography device) 5. The gantry device 2, the couch device 3, and the controller 4 are generally installed in a procedure room (examination / treatment room), while the image processing device 5 is installed in a control room adjacent to the procedure room.

  The gantry device 2 includes an X-ray irradiation device 21, an X-ray detection device 22, a high voltage generation device 23, and a C arm 24.

  The X-ray irradiation device 21 is provided at one end of the C arm 24. The X-ray irradiation device 21 is provided so as to be able to move back and forth under the control of the controller 4. As shown in FIG. 2, the X-ray irradiation device 21 includes an X-ray tube (X-ray source) 211 and a movable diaphragm device 212.

  The X-ray tube 211 receives supply of high voltage power from the high voltage generator 23 and generates X-rays according to the conditions of high voltage power.

  The movable aperture device 212 is an X-ray irradiation port of the X-ray tube 211 and movably supports an aperture blade made of a substance that shields X-rays. Note that a radiation quality adjustment filter (not shown) for adjusting the quality of the X-rays generated by the X-ray tube 211 may be provided on the front surface of the X-ray tube 211.

  The X-ray detection device 22 is provided at the other end of the C arm 24 so as to face the X-ray irradiation device 21. The X-ray detection device 22 is provided so as to be able to move back and forth under the control of the controller 4. The X-ray detection apparatus 22 includes an FPD (Flat Panel Detector) 221 and an A / D (analog to digital) conversion circuit 222.

  The FPD 221 has a plurality of detection elements arranged two-dimensionally. Between the detection elements of the FPD 221, the scanning lines and the signal lines are arranged so as to be orthogonal to each other. A grid (not shown) may be provided on the front surface of the FPD 221. In order to improve the contrast of the X-ray image by absorbing the scattered radiation incident on the FPD 221, the grid is alternately arranged with a grid plate made of lead or the like having a large X-ray absorption and easily transmitted aluminum or wood. Is done.

  The A / D conversion circuit 222 converts the projection data of the time-series analog signal (video signal) output from the FPD 221 into a digital signal and outputs it to the image processing device 5.

  The X-ray detection device 22 is an I.D. I. (Image intensifier) -TV system may be used. I. I. -In the TV system, X-rays transmitted through the subject S and directly incident X-rays are converted into visible light, and brightness is doubled in the process of light-electron-light conversion to obtain highly sensitive projection data. The optical projection data is converted into an electrical signal by using a CCD (charge coupled device) image sensor.

  The high voltage generator 23 can supply high voltage power to the X-ray tube 211 of the X-ray irradiation device 21 under the control of the controller 4.

  The C arm 24 arranges the X-ray irradiation device 21 and the X-ray detection device 22 so as to face each other with the subject S as a center. The C arm 24 causes the X-ray irradiation device 21 and the X-ray detection device 22 to move together in the arc direction of the C arm 24 under the control of the controller 4. The X-ray diagnostic apparatus 1 includes the C arm 24, and the C arm 24 is described as an example of a configuration in which the X-ray irradiation apparatus 21 and the X-ray detection apparatus 22 operate as one unit. However, the present invention is not limited to this case. Absent. For example, the X-ray diagnostic apparatus 1 may be configured to operate the X-ray irradiation apparatus 21 and the X-ray detection apparatus 22 independently without including the C arm 24.

  The bed apparatus 3 is supported on a floor surface and supports a top board (catheter table) 31. Under the control of the controller 4, the couch device 3 slides (X and Z axis directions), moves up and down (Y axis direction), and rolls. The top 31 can mount the subject S. The gantry device 2 will be described with respect to the case where the X-ray irradiation device 21 is an under tube type positioned below the top plate 31, but the X-ray irradiation device 21 is an over tube type positioned above the top plate 31. There may be some cases.

  The controller 4 includes a CPU (central processing unit) and a memory (not shown). The controller 4 drives the X-ray irradiation device 21, the X-ray detection device 22 and the C-arm 24 of the gantry device 2, and the bed device 3 for positioning according to the control of the image processing device 5. Control. Further, the controller 4 controls the operations of the X-ray irradiation device 21, the X-ray detection device 22, and the high voltage generation device 23 for surgical X-ray imaging (perspective) according to the control of the image processing device 5. .

  The image processing apparatus 5 is configured based on a computer, and performs operation control of the entire X-ray diagnostic apparatus 1, image processing related to a plurality of X-ray images (X-ray image data) acquired by the gantry apparatus 2, and the like. Device. The image processing apparatus 5 includes a system control unit 51, an X-ray image generation unit 52, an X-ray image processing unit 53, an X-ray image storage unit 54, a display unit 55, an input unit 56, an IF (interface) 57, and a partial area volume. A storage unit 58 is included.

  The system control unit 51 includes a CPU and a memory (not shown). The system control unit 51 controls the controller 4 and the units 52 to 58.

  The X-ray image generation unit 52 performs logarithmic conversion processing (LOG processing) on the projection data output from the A / D conversion circuit 222 of the gantry device 2 under the control of the system control unit 51 and adds as necessary. Process to generate an X-ray image.

  The X-ray image processing unit 53 performs image processing on the X-ray image generated by the X-ray image generation unit 52 under the control of the system control unit 51. Examples of image processing include enlargement / gradation / spatial filter processing on data, minimum / maximum value tracing processing of data accumulated in time series, and addition processing for removing noise. The data after the image processing by the X-ray image processing unit 53 is stored in the X-ray image storage unit 54.

  The display unit 55 is configured by a liquid crystal display, a CRT (Cathode Ray Tube), or the like. The display unit 55 displays various image data, which will be described later, together with character information of various parameters, scales, and the like based on the video signal under the control of the system control unit 51.

  The input unit 56 is a keyboard and a mouse that can be operated by an operator such as an operator, and an input signal according to the operation is sent to the system control unit 51.

  The IF 57 is configured by a connector that conforms to a parallel connection specification or a serial connection specification. The IF 57 has a function of performing communication control according to each standard and connecting to the network N through a telephone line, thereby connecting the image processing apparatus 5 to the network N network.

  The partial area volume storage unit 58 stores a calcification area (described later) generated by MR angiography (MRA) or CT angiography (CTA).

  FIG. 3 is a block diagram illustrating functions of the X-ray diagnostic apparatus 1 according to the present embodiment.

  When the system control unit 51 shown in FIG. 1 executes the program, as shown in FIG. 3, the X-ray diagnostic apparatus 1 has a contrast volume acquisition means 61, a partial area volume extraction means 62, an X-ray fluoroscopy execution means 71, a partial It functions as an area image generation means 72, a calcified area image generation means 73, an association means 74, an alignment means 75, and a display control means 76. In addition, although the means 61 and 62, 71 thru | or 76 which comprise the X-ray diagnostic apparatus 1 were demonstrated as what functions by running a program, it is not limited to that case. All or part of the means 61 and 62, 71 to 76 constituting the X-ray diagnostic apparatus 1 may be provided in the X-ray diagnostic apparatus 1 as hardware.

  The means 61 and 62 constituting the X-ray imaging apparatus 1 function in advance before the operation X-ray fluoroscopy, whereas the means 71 to 76 constituting the X-ray imaging apparatus 1 are used for surgery. It functions during X-ray fluoroscopy.

  Contrast volume acquisition means 61 transmits contrast volume (contrast volume data) including aorta (including descending aorta, aortic arch, ascending aorta, etc.) of subject S (shown in FIG. 1) from network N via IF 57. ). For example, the contrast volume acquisition unit 61 acquires a contrast volume generated by MR angiography (MRA) or CT angiography (CTA).

  FIG. 4 is a diagram illustrating an example of a contrast volume.

  FIG. 4 is a diagram two-dimensionally showing the contrast volume. As shown in FIG. 4, the contrast volume includes the heart region H, the aortic arch region B of the aorta above the heart region H, the BCA region P as a branching arterial region branching from the aortic arch region B, and the branching artery as well. LCA region Q and LSCA region R which is also a branch artery.

  Returning to the description of FIG. 3, the partial region volume extraction unit 62 has a function of extracting a partial region volume (partial region volume data) related to the partial region based on the contrast volume acquired by the contrast volume acquisition unit 61. The partial area volume extraction unit 62 has a function of registering the partial area volume in the partial area volume storage unit 58.

  The partial area volume extraction unit 62 extracts a partial area volume based on the area input by the input unit 56 (shown in FIG. 1) on the image based on the contrast volume displayed on the display unit 55 by a known technique. To do. Based on the contrast volume, the partial region volume extraction means 62 has high bending rate regions where the bending rate of the aortic arch region B (shown in FIG. 4) is higher than a threshold value and is likely to be calcified, and the partial regions F1 and F2 (shown in FIG. 4). Is preferable.

  The X-ray fluoroscopic executing means 71 places the subject S (both shown in FIG. 1) on the top plate 31 of the gantry device 2, and then in accordance with an instruction input from the input unit 56 (shown in FIG. 1) 4 has a function of driving and positioning the gantry device 2 and the couch device 3 (both shown in FIG. 1). Further, the X-ray fluoroscopic executing means 71 operates the X-ray irradiation device 21, the X-ray detection device 22, and the high-voltage generation device 23 (both shown in FIG. 1) on the chest including the aorta of the subject S. On the other hand, it has a function of performing fluoroscopy for surgery and collecting fluoroscopic images of a plurality of frames (each t-th (t = 1, 2,..., T) frame) via the X-ray image processing unit 53. . The fluoroscopic images of a plurality of frames generated by the X-ray image processing unit 53 are stored in the X-ray image storage unit 54.

  FIG. 5 is a diagram showing an example of a fluoroscopic image at the end diastole of the heart. FIG. 6 is a diagram illustrating an example of a fluoroscopic image at the end systole of the heart.

  FIG. 5 shows the heart region H [m] of the mth frame corresponding to the end diastole of the first to Tth frames, and the aortic arch region B [m] of the aorta above the heart region H [m]. A BCA region P [m] as a branch artery region branching from the aortic arch region B [m], an LCA region Q [m] as a branch artery, and an LSCA region R [m] as a branch artery Including. Further, high-luminance calcification regions C1 [m] to C4 [m] are generated on the inner wall surface of the aortic arch region B [m].

  FIG. 6 shows the heart region H [n] of the nth frame corresponding to the end systole of the heart among the first to Tth frames, and the aortic arch region B [n] of the aorta above the heart region H [n]. BCA region P [n] as a branch artery region branching from aortic arch region B [n], LCA region Q [n] as branch artery, and LSCA region R [n] as branch artery Including. Further, high-luminance calcification regions C1 [n] to C4 [n] are generated on the inner wall surface of the aortic arch region B [n].

  The fluoroscopic images shown in FIGS. 5 and 6 are compared with the images based on the contrast volume shown in FIG. 4 in the calcified regions C1 [m] to C4 [m] and C1 [n] to C4 [ n] is hardly visible.

  Returning to the description of FIG. 3, the partial area image generation means 72 has a function of generating an image (partial area image) based on the partial area volume registered in the partial area volume storage unit 58. The partial region image is generated as a two-dimensional image or a three-dimensional image based on the partial region volume. The two-dimensional image is a cross-sectional image (including MPR (multi-planar reconstruction)) that is an image on a plane parallel to the projection plane of the fluoroscopy by the fluoroscopy executing unit 71 based on the partial region volume. The three-dimensional image is an image that is perspective-projected in the fluoroscopic fluoroscopic direction by the X-ray fluoroscopic executing unit 71 based on the partial region volume, or an image that is parallel projected on the X-ray fluoroscopic projection plane.

  The calcified region image generating unit 73 has a function of generating a calcified region image that is an image obtained by extracting the calcified region from the partial region image generated by the partial region image generating unit 72.

  FIG. 7 is a diagram illustrating an example of a calcified region image.

  FIG. 7 shows two calcified region images in partial regions (high bending rate regions) F1 and F2 in the contrast volume shown in FIG. The calcified region image of the partial region F1 includes two calcified regions C1 and C2 with high luminance. The calcified region image of the partial region F2 includes two calcified regions C3 and C4 with high luminance.

  Returning to the description of FIG. 3, the association unit 74 has a function of extracting the calcified region on the fluoroscopic image of each frame collected by the X-ray fluoroscopic executing unit 71 using threshold processing or the like. In addition, the association unit 74 adds the calcified region on the calcified region image extracted by the calcified region image generating unit 73 to the calcified region in the partial region (high bending rate region) of the perspective image of each frame. It has a function of associating (linking). The association unit 74 associates the calcified region on the calcified region image with the calcified region in the partial region of the perspective image of each frame based on the size, shape, relative positional relationship, and the like. For example, the calcified region C1 [m] (shown in FIG. 5) in the partial region of the perspective image of the mth frame and the calcified region C1 [n] in the partial region of the perspective image of the nth frame (shown in FIG. 6). ) Is associated with the calcified region C1 (shown in FIG. 7) on the calcified region image.

  The alignment unit 75 is configured to position the calcified region in the partial region of the fluoroscopic image of each frame collected by the X-ray fluoroscopic executing unit 71 and the position of the calcified region on the calcified region image corresponding to the position. Based on the above, the calcified region image has a function of aligning with the partial region (high bending rate region) of the fluoroscopic image. The alignment means 75 positions the calcified region image with respect to the partial region of the fluoroscopic image so that the calcified region on the calcified region image overlaps the calcified region in the partial region of the fluoroscopic image. Match.

  Here, according to the prior art, the entire images are aligned with reference to landmarks such as bones on both images.

  FIG. 8 is a diagram illustrating a chest contrast image that is aligned with a fluoroscopic image at the end diastole according to the prior art. FIG. 9 is a diagram showing a chest contrast image that is aligned with the end-systolic fluoroscopic image according to the prior art.

  FIG. 8 shows an image obtained by aligning the entire chest contrast image with the bone as a landmark in the perspective image of the m-th frame shown in FIG. FIG. 9 shows an image obtained by aligning the entire chest contrast image with the bone as a landmark in the perspective image of the nth frame shown in FIG.

  As shown in FIG. 8, when the phase of the chest contrast image is not at the end diastole, the positions of the calcified regions C1 [m] and C1, the positions of the calcified regions C2 [m] and C2, and the calcified region C3 [ The positions of m] and C3 and the positions of the calcified regions C4 [m] and C4 do not match.

  As shown in FIG. 9, when the phase of the chest contrast image is not the end systole, the positions of the calcified areas C1 [n] and C1, the positions of the calcified areas C2 [n] and C2, the calcified areas The positions of C3 [n] and C3 and the positions of calcified areas C4 [n] and C4 do not match.

  FIG. 10 is a diagram showing a calcified region image that is aligned with a partial region of the end-diastolic fluoroscopic image by the alignment unit 75 according to the present embodiment. FIG. 11 is a diagram showing a calcified region image that is aligned with a partial region of the end-systolic fluoroscopic image by the alignment unit 75 according to the present embodiment.

  FIG. 10 is based on the calcification regions C1 [m] and C2 [m] in the partial region F1 of the end-diastolic perspective image shown in FIG. 5 and the calcification regions C1 and C2 on the calcification region image. The calcified region image is aligned with the partial region F1 of the fluoroscopic image, and the calcified regions C3 [m] and C4 [m] in the partial region of the fluoroscopic image at the end diastole are displayed on the calcified region image. The image after the calcification area image is aligned with the partial area F2 of the fluoroscopic image based on the calcification areas C3 and C4 is shown.

  FIG. 11 is based on the calcification regions C1 [n] and C2 [n] in the partial region F1 of the fluoroscopic image at the end systole shown in FIG. 6 and the calcification regions C1 and C2 on the calcification region image. The calcified region image is aligned with the partial region F1 of the fluoroscopic image, and the calcified regions C3 [n] and C4 [n] in the partial region F2 of the fluoroscopic image at the end systole and on the calcified region image The image after the calcification area image is aligned with the partial area F2 of the fluoroscopic image based on the calcification areas C3 and C4 of FIG.

  As shown in FIG. 10, even when the phase of the calcified region image (shown in FIG. 7) is not at the end diastole, the calcified region image is located in the partial region of the fluoroscopic image with reference to the corresponding calcified regions. Since they are combined, the positions of the calcified areas C1 [m], C1, the positions of the calcified areas C2 [m], C2, the positions of the calcified areas C3 [m], C3, the calcified areas C4 [m], C4 The positions of are substantially the same.

  Further, as shown in FIG. 11, even when the phase of the calcified region image (shown in FIG. 7) is not the end systole, the calcified region image is displayed in the partial region of the fluoroscopic image with the corresponding calcified regions as a reference. Are aligned, the positions of the calcified areas C1 [n] and C1, the positions of the calcified areas C2 [n] and C2, the positions of the calcified areas C3 [n] and C3, and the calcified area C4 [n]. , C4 substantially coincide with each other.

  Returning to the description of FIG. 3, the display control unit 76 combines the calcified region image aligned by the alignment unit 75 with the partial region of the fluoroscopic image of each frame collected by the X-ray fluoroscopic execution unit 71. A function of causing the display unit 55 to display the composite image (overlapped); The synthesized image is obtained by synthesizing the calcified region image aligned in real time with the fluoroscopic image. The display control means 76 synthesizes the synthesized image together with character information and scales of various parameters, and outputs the synthesized image to the display unit 55 as a video signal.

  According to the display using the conventional technique, a fixed calcification region C1 is arranged on a fluoroscopic image (moving image) including a calcification region C1 [t] that periodically moves according to the heartbeat. . On the other hand, according to the display by the display control means 76 according to the present embodiment, the calcification region arranged in accordance with the movement in the calcification region (partial region) that periodically moves according to the heartbeat in the fluoroscopic image. It becomes a display form in which (calcified region image) is arranged.

  FIG. 12 is a diagram illustrating an example of a composite image based on a fluoroscopic image at the end diastole displayed by the display control unit 76 according to the present embodiment. FIG. 13 is a diagram illustrating an example of a composite image based on a fluoroscopic image at the end systole displayed by the display control unit 76 according to the present embodiment.

  The composite image shown in FIG. 12 is displayed in the aortic valve replacement procedure, so that the surgeon grasps the positional relationship between the leading end of the real-time catheter K and the calcification regions C3 and C4 aligned in real-time synchronization. The catheter K can be advanced while moving. Further, when the catheter K advances, the composite image shown in FIG. 13 is displayed, so that the operator can adjust the leading end of the real-time catheter K and the calcification regions C1 and C2 aligned in real-time synchronization. The catheter K can be advanced while grasping the positional relationship. That is, in the aortic valve replacement procedure, the composite image shown in FIGS. 12 and 13 is displayed, thereby suppressing the risk that the leading end of the catheter K contacts the calcification site (calcification region C1, C2, C3, C4). be able to.

  Further, the display control means 76 shown in FIG. 3 detects the position of the catheter provided with the position sensor, and the distance between the position of the catheter traveling in the blood vessel in real time and each calcified region on the calcified region image is determined. When the threshold value is less than or less than the threshold value, the operator may have a function of visually or audibly alerting the operator.

  Subsequently, the operation of the X-ray diagnostic apparatus 1 of the present embodiment will be described with reference to FIGS. 1, 14, and 15.

  14 and 15 are flowcharts showing the operation of the X-ray diagnostic apparatus 1 according to this embodiment. Note that steps ST1 to ST3 shown in FIG. 14 are steps before fluoroscopy for surgery, whereas steps ST11 to ST17 shown in FIG. 15 are steps during fluoroscopy for surgery.

  First, as shown in FIG. 14, the X-ray diagnostic apparatus 1 shown in FIG. 1 acquires a contrast volume (shown in FIG. 4) of the chest including the aorta of the subject S from the network N via the IF 57 (steps). ST1). For example, the X-ray diagnostic apparatus 1 acquires a contrast volume generated by MR angiography or CT angiography.

  The X-ray diagnostic apparatus 1 extracts a partial region volume (shown in FIG. 7) based on the contrast volume acquired in step ST1 (step ST2). The X-ray diagnostic apparatus 1 registers the partial area volume extracted in step ST2 in the partial area volume storage unit 58 (step ST3).

  15, after placing the subject S on the top plate 31 of the gantry device 2, the gantry device 2 and the couch device 3 (both in FIG. 1) via the controller 4 in accordance with an instruction input from the input unit 56. To adjust the position. Then, the X-ray diagnostic apparatus 1 acquires the partial region volume registered in step ST3 (shown in FIG. 14), and generates a calcified region image related to the calcified region in the partial region of the partial region volume (step ST11). ).

  When there is an instruction to start fluoroscopic image collection, the X-ray diagnostic apparatus 1 operates the X-ray irradiation device 21, the X-ray detection device 22, and the high voltage generation device 23 to operate the chest including the aorta of the subject S. On the other hand, surgical fluoroscopy is started (step ST12), and fluoroscopic images (shown in FIGS. 5 and 6) of the t-th frame are collected (step ST13). Then, a procedure for the operator to insert a catheter into the subject S, for example, an aortic valve replacement procedure is started.

  The X-ray diagnostic apparatus 1 associates the calcified region on the calcified region image generated in step ST11 with the calcified region in the partial region of the fluoroscopic image of the t-th frame collected in step ST13 (step ST14). . The X-ray diagnostic apparatus 1 then matches the position of the calcified region in the partial region of the fluoroscopic image of the t-th frame collected in step ST13 with the calcified region on the calcified region image associated in step ST14. The calcified region image is aligned with the partial region of the fluoroscopic image of the t-th frame based on the position of (step ST15).

  The X-ray diagnostic apparatus 1 synthesizes (superimposes) the calcified region image registered in step ST15 on the partial region of the fluoroscopic image of the t-th frame collected in step ST13 (see FIGS. 12 and 12). 13 is displayed on the display unit 55 (step ST16).

  The X-ray diagnostic apparatus 1 determines whether or not there is an instruction to end the fluoroscopic image collection in step ST13 (step ST17). If YES in step ST17, that is, if it is determined that there is an instruction to end the collection of fluoroscopic images, the X-ray diagnostic apparatus 1 ends the operation.

  On the other hand, if the determination in step ST17 is NO, that is, if it is determined that there is no instruction to end fluoroscopic image collection, the X-ray diagnostic apparatus 1 collects fluoroscopic images for the next (t + 1) th frame (step t). ST13).

  According to the X-ray diagnostic apparatus 1 according to the present embodiment, since the calcified region image including the calcified region at the position corresponding to the frame is synthesized with the partial region of the fluoroscopic image of each frame, the pulsation of the heart is added to the fluoroscopic image. In the case where the position variation due to the above occurs, it is possible to display an image obtained by synthesizing an appropriate calcified region image according to the position variation. Therefore, according to the X-ray diagnostic apparatus 1 according to the present embodiment, it is possible to support a catheter advancing technique that should avoid contact with a calcified site.

(Modification)
Since the data registered by the partial region volume storage unit 58 shown in FIG. 3 is three-dimensional data, the calcified region image generating means 73 calculates the three-dimensional information of each calcified region on the calcified region image. Can do. The calcified region image generating means 73 calculates characteristic information indicating at least one of the volume and thickness (maximum height from the blood vessel wall) of each calcified region on the calcified region image. In that case, the display control means 76 further synthesizes the characteristic information with the synthesized image and causes the display unit 55 to display it. In that case, the display control means 76 should just make the characteristic information synthesize | combined at least 1 among an arrow, a character display, and a numerical value.

  Further, when there is a switching operation via the input unit 55, the display control unit 76 may be configured to switch the information of the calcification regions C1 to C4 combined with the fluoroscopic image to the characteristic information.

  FIG. 16 is a diagram illustrating an example of a combined image in which characteristic information is combined.

FIG. 16 shows a composite image obtained by further combining characteristic information with the composite image shown in FIG. Characteristic information indicating volume and thickness is synthesized in each calcified region portion of the synthesized image shown in FIG. The volume of the characteristic information is indicated by a numerical value of "2.1 mm ^3" and "5.3 mm ^3". The thickness as the characteristic information is indicated by numerical values “1.2 mm” and “2.1 mm”.

  Further, the thickness as the characteristic information is indicated by the length of the arrow. Further, since each calcified region has three-dimensional information, the depth direction and its length may be indicated as characteristic information. In FIG. 16, the depth direction as the characteristic information and its length are indicated by the direction length of the arrow.

  Although several embodiments of the present invention have been described above, these embodiments are presented as examples and are not intended to limit the scope of the invention. These novel embodiments can be implemented in various other forms, and various omissions, replacements, and changes can be made without departing from the scope of the invention. These embodiments and modifications thereof are included in the scope and gist of the invention, and are included in the invention described in the claims and the equivalents thereof.

DESCRIPTION OF SYMBOLS 1 X-ray diagnostic apparatus 2 Base apparatus 21 X-ray irradiation apparatus 22 X-ray detection apparatus 4 Controller 5 Image processing apparatus 51 System control part 55 Display part 56 Input part 58 Partial area volume storage part 61 Contrast volume acquisition means 62 Partial area volume extraction Means 71 X-ray fluoroscopic executing means 72 Partial area image generating means 73 Calcified area image generating means 74 Corresponding means 75 Positioning processing means 76 Display control means

Claims (9)

An X-ray generator for generating X-rays on the subject;
An X-ray detector that is disposed opposite to the X-ray generator and detects the X-ray;
Based on the X-ray, a fluoroscopic image generation unit that sequentially generates a multi-frame fluoroscopic image;
Calcified region image generating means for generating a calcified region image related to the calcified region in the partial region volume based on the contrast volume data of the subject obtained in advance;
A detection unit for sequentially detecting calcification regions on the fluoroscopic images of the plurality of frames;
A display control unit that sequentially superimposes the generated calcified region images on the position of the calcified region of the plurality of frames of the fluoroscopic images and sequentially displays them on the display unit;
X-ray diagnostic apparatus. The detection unit detects the calcification region for a plurality of partial regions on each perspective image of the plurality of frames of the perspective image,
The X-ray diagnostic apparatus according to claim 1. The detection unit detects the calcification region for the plurality of partial regions where the bending rate of the blood vessel on each of the fluoroscopic images is larger than a threshold value .
The X-ray diagnostic apparatus according to claim 2. Based on the position of the medical instrument inserted into the subject and the position of the calcification region, further has a notification unit that notifies the user,
The X-ray diagnostic apparatus as described in any one of Claims 1 thru | or 3. The notification unit performs the notification when the position of the medical instrument and the position of the calcification region are less than a predetermined distance.
The X-ray diagnostic apparatus according to claim 4. The position of the medical device is detected based on a position sensor provided in the medical device.
The X-ray diagnostic apparatus according to claim 5. The notification unit performs the notification by sound or display by the display unit.
The X-ray diagnostic apparatus as described in any one of Claims 4 thru | or 6. The display control unit sequentially superimposes information indicating a calcification range or thickness in the calcification region image on the fluoroscopic images of the plurality of frames and causes the display unit to sequentially display the information.
The X-ray diagnostic apparatus as described in any one of Claims 1 thru | or 7. The calcified region image further includes an alignment unit that sequentially aligns the partial region including the calcified region on the perspective image of the plurality of frames,
The display control unit sequentially superimposes the aligned calcified region images on the positions of the calcified regions of the plurality of frames of the fluoroscopic images and sequentially displays the images on the display unit.
The X-ray diagnostic apparatus as described in any one of Claims 1 thru | or 8.

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